Organisational Justice and workers’ health Findings from Whitehall II and other studies Jane E. Ferrie Department of Epidemiology and Public Health University College London

Social Justice or Fairness the quality of treating people equally or in a way that is right and reasonable

Fundamental behaviour? the brown capuchin monkey (Cebus apella) published in Nature 2003 Early evolutionary origin of aversion to injustice?

Experiment Monkeys were taught in pairs to give a token to the experimenter. In return they were given a reward of food. The food could be highly prized (high reward) or less exciting (low reward). When the monkeys saw that both monkeys in the pair got the same reward in exchange for their token, 95% happily exchanged their token for the reward. When the monkeys witnessed their partner get a high value reward for equal effort over half of them refused to participate and would not hand in their tokens for exchange. The refusal rate increased to 80% if the monkeys witnessed their partner get high value reward without handing the token to the experimenter at all. Brosnan & de Waal. Nature 2003

Experiments in humans Using neoroimaging studies have shown that unfair transactions activate the bilateral anterior insula, areas of the brain associated with negative emotional states. Anterior insula activation is consistently seen in neuroimaging studies of pain and distress, hunger and thirst, and autonomic arousal – one of the responses to stress. Sanfey et al Science 2003

General unfairness or injustice Odds ratio* De Vogli et al (2007) J Epidemiology and Community Health *adjusted for socio-demographic, psychosocial and behavioural risk factors and health at baseline Justice

Organisational justice refers to the extent to which workers or employees are treated with justice at their workplace

Organisational Justice Components Procedural component –decision-making procedures include input from affected parties, are consistently applied, open and ethical Relational component –respectful and considerate treatment of workers and employees by their supervisors

Rate*/ odds ratio* Elovainio, Kivimäki, Vahtera (2001) Am J Public Health *adjusted for demographic and behavioural risk factors Organisational justice Early work

Depressive disorders Lopez et al. Global burden of disease and risk factors WHO 2006 The leading cause of YLD (years of healthy life lost as a result of disability) in high-income countries

CauseYLD (millions of years) Percent of total YLD 1. Unipolar depressive disorders Alzheimer's and other dementias Hearing loss, adult onset Alcohol use disorders Osteoarthritis Cerebrovascular disease Chronic obstructive pulmonary disease Diabetes mellitus Endocrine disorders Vision disorders, age-related leading causes of YLD* (millions of years) in high-income countries (WHO 2006) Lopez et al. Global burden of disease and risk factors 2006 *Years of healthy life lost as a result of disability

Lack of control Job demands Job strain Injustice Organisational justice, other work stressors and newly diagnosed depression Ylipaavalniemi, Kivimäki et al. Soc Sci Med Source of stress Odds ratio

Does self-reported justice reflect actual managerial treatment... or the characteristics of the worker?

Individual and work unit level assessment of organisational justice Source: Kivimäki et al. (2003). Psychological Medicine

Cardiovascular disease The leading cause of premature death in high income countries

Organisational justice and cardiovascular disease in the Whitehall II study Longitudinal study of 6,442 men, British civil servants aged 35 to 55 years who had no prevalent CHD at baseline 1985 – 1988 Baseline screening (Phase 1) CHD risk factors, organizational justice & work stress 1989 Questionnaire only (Phase 2) Organizational justice & work stress 1990 – 1999 Follow-up, clinical records (after Phase 2) Clinical records of CHD death, first non-fatal myocardial infarction or definite angina (250 incident CHD cases during the mean follow-up of 8.7 years) Kivimäki et al. Arch Intern Med. 2005;165:

Risk for Coronary Heart Disease Organizational Justice Hazard Ratio Kivimäki et al. Arch Intern Med. 2005;165: (95% CI 0.78, 1.41) 0.65 (95% CI 0.47, 0.91)

Unfair supervisors can raise your blood pressure Systolic BP 12 mm Hg higher increases in systolic BP during workdays under less favoured supervisor than those of the control group (p=0.001) mm Hg higher systolic BP during workdays under a less favoured supervisor compared to a favoured supervisor (p=0.001) Wager et al. Occup Environ Med 2003;60:

Relational justice and CVD death or hosptiatisation for back disorders Cardiovascular mortality Hazard Ratio (adj. for age, sex, job strain, ERI) Kaila-Kangas, Kivimäki et al. the Valmet Study. Spine ( ) Hospitalization for back disorders (not intervertebral disc disorders) Hazard Ratio ( ) "My supervisor treats me fairly" Supervisory support 0.6 ( ) 1.0 Elovainio, Leino-Arjas, Vahtera, Kivimäki. the Valmet Study. J Psychosom Res 2006

Does a change in organisational justice lead to a change in health?

Change in Organisational Justice Odds of new-onset minor psychiatric morbidity Ferrie et al. Occup Environ Med 2006 Kivimäki et al. J Epidemiol.Comm.Health 2004 Odds of poor physical health 1.23 ( ) 0.61 ( ) 1.00

High justice Low Justice Commitment Don’t leave job Job performance Conflict resolution Decision acceptance Job satisfaction Retaliation Withdrawal Theft Stress (C) overt disobedience Other effects of organisational justice Greenberg & Cropanzano 2001

Summary Organisational injustice is a workplace stressor It has been shown to be associated with minor psychiatric disorder and depression poor physical health coronary heart disease hospitalisation for back problems sickness absence premature cardiovascular death poor organisational outcomes Levels of organisational justice can be improved Higher levels of justice improve health, decrease sickness absence and improve organisational outcomes